“Courage starts with showing up and letting ourselves be seen.” ~ Brené Brown
I am always encouraged to see social media being used for community building and making people feel less alone in the world. You may have heard about the viral hashtag “MeToo” that followed sexual allegations against Hollywood producer Harvey Weinstein. Not only did these allegations lead to a domino effect against Weinstein, they lead to a #MeToo frenzy on social media following this tweet by the actor Alyssa Milano:
The magnitude of the problem is most certainly becoming apparent, and as some people have pointed out, this isn’t an issue exclusive to women – it can happen to men too. A fellow blogger at Real Life Health (and Vancouver Islander too) posted a very honest, personal message in response to this movement. In her post, she included some relatable language such as catcalls and being flashed. An immediate realization washed over me that sexual violence starts somewhere, so why have many of these inappropriate behaviours been normalized or brushed off by so many of us?
As a female physician
As I unpack more in my own life that falls within this #MeToo campaign, I think one of the most undiscussed and distressing commonalities as a female physician is when sexual harassment is directed at us by a patient. Sorry, this is about to get real, but isn’t that what this is all about? Uncovering the magnitude of the problem.
In my 17 years as a practicing physician, I can think of a few times that left me realizing how vulnerable we can be as physicians on the other side of the examining room – not many, but enough. An incident happened not to long ago in my 40’s so age is not a predictor. Nor is the way you dress, talk, look, etc . Often as a victim, you look at your potential role in the incident as opposed to where you must look – squarely on the offender. I wasn’t sure how to fully handle the most recent incident. Fortunately, I was able to move passed it with the support of my husband, but this conversation made me realize that I should look into it for my female colleagues wondering the same thing.
As it turns out, this is a very common occurrence for female physicians where they report having been sexually harassed at some point by a patient (usually a male). Interestingly, the articles I found published on this, in reputable medical journals, were written between 1993 and 1997 by the same author(s). I didn’t find any articles subsequent to these that I could refer to despite the obvious need for further discussion on this matter.
In one of the articles Sexual Harassment of Female Physicians by Patients – What is to Be Done? by Dr. Susan Phillips (a fellow Canadian I might add), she hits this issue square on with why we feel so vulnerable: “Physicians lack legal protection from sexual harassment by patients. The physician is generally not an employee and has no relevant contractual agreement with her patient.”
In this study, Phillips sent questionnaires regarding sexual harassment to female physicians in Ontario at the time. Of the 70% that replied, 76% reported sexual harassment by patients. Just as shockingly, none of these female physicians reported the harassment or pressed charges. “Perhaps they, like their counterparts in other settings, were immobilized by awareness of the difficulty of proving anything and the fear of loss of privacy.”
Phillips indicates some physicians self-blamed (internalized the reason for the behavior, what they wore or how they looked), blamed it on a psychiatric illness of the patient or justified that perhaps it had been accidental as opposed to intentional.
Where to go from here?
Fortunately, much has been shared and published about gender bias, discrimination and harassment in the medical environment, such as during medical education, or by colleagues, but clearly the issue that exists in the physician-patient setting is not being discussed. The study by Phillips was many years ago and she encouraged further discussion and collective work towards answers, but based on my online research, this doesn’t exist. I couldn’t find any information from either some of the governing bodies or medical associations.
Based on my own experiences, this continues to be a problem that is not discussed, and therefore, the physician is left to navigate it on their own. Given the valid concern with confidentiality, and the shame that comes from being sexually harassed, it puts the physician in a precarious and anxiety-provoking situation. For me, I was able to clearly outline to the places I worked that I would not see the patient in question again. In another instance, the patient should have been dismissed by us, but for many reasons was not. Dismissing, or firing, a patient comes with its own procedures and policies and is not that straightforward for physicians. I would guess too that some physicians don’t feel they have the authority/freedom to decide on whom they do and don’t see depending on their clinical environment.
This is one of those topics that would be easier to avoid, but I’m glad #MeToo opened up the platform to highlight sexual harassment and the magnitude of the problem. As always, the hope is that these types of discussions will help others.
I would really love some feedback on this topic and I do have some other ideas to share. If you want to connect, or know someone who might, please do so via e-mail at firstname.lastname@example.org.
Phillips, S. (1996). Sexual Harassment of Female Physicians by Patients: What is to Be Done? Canadian Family Physician. 42: 73-78.
Phillips, S. and Schneider, M. (1993). Sexual Harassment of Female Doctors by Patients. The New England Journal of Medicine (NEJM). 329: 1936-1939.
Schneider, M. and Phillips, S.P. (1997). A Qualitative Study of Sexual Harassment of Female Doctors by Patients. Social Science & Medicine. 45(5): 669-676.
O’Malley, O.S., Swankoski. K., Peikes, D. et al. (2017). Patient Dismissal by Primary Care Practices. The Journal of the American Medical Association (JAMA). 177(7): 1048-1050.